Development and Pilot of MySafeCare: An Application for Patients and Family to Report

Safety Concerns in the Hospital Sarah A Collins, RN, PhD, Senior Clinical and Nurse Informatician, Partners Healthcare Systems;

Instructor in Medicine, Harvard Medical School & Brigham and Women’s Hospital, sacollins@partners.org

MySafeCare Team: Brittany Couture, Esteban Gershanik MD, MPH, Ann DeBord Smith MD, MPH,

Frank Chang, Elizabeth Lilley MD, MPH

Funded by AHRQ IP30HS0235335 Making Acute Care More Patient Centered (PI: Bates)

Brigham and Women’s Hospital

David Bates Alex Businger Sarah Collins

Esteban Gershanik Elizabeth Liley

Brittany Couture Anuj Dalal

Patricia Dykes Emily Leung Stuart Lipsitz

Eli Mlaver Ronen Rozenblum Jeffrey Schnipper Kumiko Schnock

Partners HealthCare Frank Chang

Ramesh Bapanapalli Mohan Babu Ganasekaran

Gennady Gorbovitsky

James Benneyan

Corey Balint Jennifer Coppola Nicholas Fasano Zachary Katsulis

Meredith Clemmens Lindsey Baldo Awatef Ergai

Dominic Breuer Jillian Hines

Jessica Cleveland

Patient Safety Learning Lab Team

Northeastern Institute of Healthcare Systems Engineering

Introduction

• There is a limited understanding of threats to patient safety from the patient’s perspective

• A method to capture patient perceived threats in real time could:

– Help mitigate risks before safety incidents occur

– Promote a learning health system

• How can we use technology to:

– Capture patient perceived threats in real time?

– Overcome barriers that prevent patients from reporting safety concerns?

What’s the evidence?

• Surveyed patients identify 55- 66% more events

– Not captured in health record or event reporting system1,2-4

• Engaging patients at the point of care and in real time, not after

– Improved outcomes

» Decrease likelihood of adverse events9

» Improved cost-savings

– Decreased delays in care, errors, and length of stay

– HCAHPS Scores (Hospital Consumer Assessment of Healthcare Providers and Systems)

– Improved process measures

» Increase satisfaction2,4

» Better data

(1Weissman et al., 2008; 2Weingart et al., 2005; 3Weingart et al., 2006; 4Currie, et al., 2009)

Healthcare Landscape

• Safety reporting systems are cumbersome • Easy to forget reporting ‘near misses’ • Apps are simple, fast, accessible in real-time

“Patients and families can play a critical role in preventing medical

errors and reducing harm… Many of the barriers to engagement faced by patients and families – such as lack of access to their

health records, intimidation, fear of retribution, and lack of easy to understand tools and checklists for enhancing safe care – can only be overcome if leaders and clinicians support patients and

families to become more confident and effective in their interactions with health care providers.”

(Lucian Leape Institute. Safety is Personal: Partnering with Patients and Families for the Safest Care. The

National Patient Safety Foundation, 2014)

Healthcare Landscape

Patient Observations

Clinician Observations

Patient and Family Advisory Council

Patient Safety, Event Reporting

HCAHPS Scores

My Safe Care To Enable A Real-time Response

About MySafeCare

MySafeCare is a research tool that allows patients and their friends and family a real-time way to report safety concerns to appropriate clinical staff while in the hospital

Key Features:

• Web-based and mobile-enabled

• Anonymous and Identified reporting options

• Concern Categories (button icons) and subcategories

• Free text section for “in your own words”

• May enter a Compliment

MySafeCare App

9 Concern Categories

Subcategories

Free text section

Patient Facing Application

Clinical Dashboard

Purpose

Provide anonymous & identified reporting of safety concerns for inpatients and families

Web-based and mobile enabled for real-time and quick reporting

IS Implications Standalone application accessed by any

mobile device with internet access Facilitates communication between

hospital administration/staff and patients and families

Clinical Dashboard can be opened up to Nurse/Medical Directors, Patient and Family Relations staff, and clinical team

Aims

1. Iterative user-centered development

2. Pilot Testing

3. Quantitative analysis of submissions captured through MySafeCare

4. Qualitative analysis of the unique perspectives of patients and families related to reporting safety threats identified and explored in this project

Methods

• Stakeholder engagement – Clinical units, Patient and Family Advisory Councils, Patient Safety

• User-centered design & usability testing

– Development work to produce a configurable system

• Pilot Testing

• Outcomes Analysis

User Centered Design Methods

• Rapid iterative development and piloting

1. Stakeholder engagement

2. Iterative user-centered design

3. Extraction and prioritization of requirements

4. Wireframes and prototyping

5. Development

6. Testing

7. Version revisions based on testing and end-user feedback

Pilot Testing on Clinical Units

• Version 1

– 3 weeks during March - April 2015

» Vascular Surgery unit

• Version 2

– 6 month trial during May - October 2015

» Medical Intensive Care Unit (MICU)

» Oncology Units (ONC)

• Version 3

– February 2016 – now

» MICU and ONC

– April 2016 - now

» Vascular Surgery unit

Other Safety & Healthcare

Outcomes

Configuration 2

Schematic of Outcomes

• Unit level data • Duration of stay on

unit • Patient satisfaction

(HCAHPS) • Adverse events on

unit

• Survey data on 3 domains: • Attitudes • Comfort • Responsibility

Patient & Family

Willingness to Engage

Patterns of Utilization

• Iterative process • New concern

categories • Discarded categories

• Qualitative feedback from patient/family users

• Survey responses from clinician users

• Concern submissions • Types • Quantity

• Hospital unit • MICU • Oncology

• User • Patient • Family or friend

User-Centered

Design

Configuration 3

Comparison of Outcomes

MySafeCareMySafeCare

Configuration 1

Results: Sample & Data Collected

• User-Centered Design

– 11 individual user-centered design sessions

– 3 small group user-centered design sessions

» 25 members of PFAC

» Average 6-10 participants

– Consisted of a combination of former patients and family members

• Pilot Sample

– > 250 interactions with patients and families during engagement rounds

» Version 1 - Intermediate Vascular Unit pilot trial

– 44 patients engaged

» Version 2 - Medical ICU and Oncology floors pilot

– 206 patients and family members engaged

» Version 3 – in process

Hackathon fall 2013

SharkTank spring 2014

AHRQ fall 2014

Project Execution Timeline

Hackathon fall 2013

SharkTank spring 2014

AHRQ fall 2014

Project Execution Timeline

Clinical, Administrative, & Research Leadership Engagement and Support

BWH Innovation Hub (iHub)

• Stakeholder engagement

• Low feasibility prototypes

• Grant writing

Pitching

• Stakeholder engagement

• High feasibility prototypes

• User-centered design

• Governance alignment

Piloting

• Stakeholder engagement

• Iterative development

• Versioning

• Implement

• Data collection

Executing

Partners/BWH Governance and IT Infrastructure and Services

BWH Patient and Family Advisory Council & Patient and Familiy Relations

Department Name

– Quantitative Pilot Data

» Pre-publication and will be included in live presentation

– Concerns Submissions

» Counts: comparable with Patient & Family Relations data

» Content: useful and unique

– Example: • Patient perceived harm related to intravenous infection control was in reality a

best practice.

– Interviews

» The majority of patients/families interviewed were unaware of the administrative ‘chain of command’ of the hospital and paths for reporting a safety concern in the hospital

Results

Discussion: Safety reporting by Patients & Families

• Patient preferences

– Anonymous concerns

• Patient perspective

– Mitigate actual harms & perception of harm

• Patient engagement

– Introduction to MySafeCare

– Patient Population

• Patient education

– Knowledge of the “chain of command”

– Value of reporting

Current & Next Steps

• Expansion to other units to test level of use & planned outcomes across different patient populations

• Continue to test Patient/Family engagement strategies

– Best process for introduction of MySafeCare

– Refinement of terms

• Analysis of Patient/Family Willingness to Engage

– Mixed methods: qualitative interview data & quantitative survey data

• Ongoing, agile revisions to MySafeCare content for improved user experience

• Intervention trial

– Integration with other safety projects

Thank you & Questions

• Acknowledgements:

– This work was funded by AHRQ 1P30HS0235335 Making Acute Care More Patient Centered.

– Software development of MySafeCare was completed by OpenClinica, LCC.